[Late complications of subarachnoid hemorrhage from ruptured aneurysms treated with early and delayed surgery]

Result of studies on remote sequele of SAH from ruptured brain aneurysms are presented. The investigation have been pointed at the character, range and intensity of some changes in CNS initiated by SAH and resulting from this bleeding. The material comprised of 110 patients: 48 out of this number having been operated on within 72 hours from initial bleed, while 62 have had surgery in delayed term. Three methods of investigations were applied: 1. Angioscintigraphy of the brain. 2. Computerized tomography. 3. Clinical evaluation according to GOS (Glasgow Outcome Scale). The results obtained seem to give reasons to assumption that SAH initiates the gradual process of degradation of the CNS tissues. The blood extravasated to the subarachnoid space following aneurysm burst sets in motion a chain of events leading to: 1) impairment of brain arteries reactivity on elevation of pCO2, 2) intensification of brain atrophy. The intensity of the above mentioned phenomena is proportional to the severity of clinical course of SAH. It came out that timing of surgery has influenced the remote postoperative results less than it had been expected.